© 2007 Foundation for Promotion of Cancer Research
Total Pelvic Exenteration with Sacrectomy for Re-Recurrence of Rectal Cancer
Colorectal Surgery Division
National Cancer Center Hospital
Tokyo
A 58-year-old male had undergone low anterior resection for rectal cancer at a territorial hospital (well-differentiated adenocarcinoma, Dukes A, T2N0M0). Three years later, he developed a local recurrence on the surgical suture line and underwent abdomino-perineal resection (APR) at the same hospital. However, one year after APR, re-recurrence of the tumor in the pelvis was suspected, and he was referred to our hospital for a further treatment.
Extensive examination using CT and MRI demonstrated a localized bulky pelvic tumor (13 x 6 cm in size) without distant metastasis. The present tumor extended from the second sacral vertebra (Fig. 1, white arrow) to the perineum (white arrow head) and lay adjacent to the bladder (black arrow), the prostate (*) and the sacrum in MRI. Neoadjuvant chemoradiotherapy was administered using 5FU and total dose of 50.4 Gy for local radiation, but it was not effective. Subsequently, total pelvic exenteration with subtotal sacrectomy (solid line) and perineal reconstruction using left gluteal musclocutaneous flap was performed. The postoperative course was uneventful and the patient is doing well without recurrence one year after surgery. The final pathological diagnosis confirmed recurrence of rectal cancer and surgical margin was negative.
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